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Expert Highlights Expanding Options for HER2+ Breast Cancer

Danielle Bucco
Published: Monday, Nov 27, 2017

Lajos Pusztai, MD
Lajos Pusztai, MD
Additional treatment options are emerging for patients with HER2-positive breast cancer, according to Lajos Pusztai, MD.

, Pusztai, a professor of medicine, chief of Breast Medical Oncology, Yale Cancer Center and Yale School of Medicine, discussed neoadjuvant and adjuvant treatment decisions for patients with HER2-positive breast cancer, as well as the potential of immunotherapy in the metastatic setting.

OncLive: What data do we have supporting neoadjuvant therapy for patients with HER2-positive breast cancer?

Pusztai: HER2-positive disease has become rich in treatment options, which sometimes creates confusion with how to best select treatments for patients. In the neoadjuvant setting, combining trastuzumab, pertuzumab (Perjeta), and a third-generation chemotherapy of paclitaxel followed by doxorubicin hydrochloride (Adriamycin) and cyclophosphamide (AC) or AC followed by paclitaxel and either of the targeted therapies, produces pathologic complete response (pCR) rates of 75% to 80% in the estrogen receptor (ER)-negative subset and 50% to 60% in the ER-positive subset. Current therapies can accomplish high pCR rates. 

This is based on the idea that those with residual disease have a higher risk, and these regimens are better than the simpler and much less expensive single-agent trastuzumab approach. The high-risk patients might benefit from costly and more toxic regimens than standard adjuvant therapy with trastuzumab.

We are seeing early signals of PD-1 in TNBC. Do you think there is potential for immunotherapy for patients with HER2-positive breast cancer?

In the early-stage disease setting, I-SPY randomized patients with ER-positive breast cancer to receive standard-of-care chemotherapy or chemotherapy combined with pembrolizumab. This also showed an improvement in pCR rates. In the I-SPY study, this combination graduated for most of these subsets. I am not aware of any major studies currently ongoing in the neoadjuvant space for ER-positive disease. 

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